Obesity.

Abstract

Introduction: Bariatric surgery is associated with improvement of obesity related co-morbidities. Some studies suggest that these patients may be susceptible to alcohol abuse due to alteration in metabolism. Aim of this study was to assess the impact of bariatric surgery on high risk alcohol use in a meta-analysis of the published data. Methods: MEDLINE and Embase were searched from inception through September 2016 with MeSH terms “alcohol”, “substance abuse”, “outcomes”, and “bariatric surgery”. Dual extraction and quality assessment of studies was performed independently by two authors. Inclusion criteria were retrospective and prospective studies reporting long-term outcomes (>12 months) after bariatric procedures, with >100 patients in a cohort, and reporting rates of alcohol use as per the AUDIT, dSCID criteria and data from inpatient alcohol treatment. Primary outcomes included the pooled event rate and 95% confidence interval (95% CI) for significant alcohol use after bariatric surgery, new-onset significant alcohol use after bariatric surgery and odds ratio comparing rates of alcohol abuse before and after surgery. Results: 565 citations were identified;12 prospective and 16 retrospective or cross-sectional cohort studies including 15,714 subjects were analyzed. Average follow-up was 2.6 years(range 0.08-10 years). Average age of participants ranged from 26.5-50.1 years, with 76.8% female. Majority of patients had undergone Roux-en-Y gastric bypass and fewer had laparoscopic gastric banding/other restrictive procedures. New-onset significant alcohol use was identified in 8% of patients after bariatric surgery. 19% of patients had significant alcohol use prior to bariatric surgery, event rate 0.19(95% CI 0.12-0.28,18 studies,4697 patients). 23% of patients had significant alcohol abuse after bariatric surgery; event rate 0.23(95% CI 0.14-0.34,I2=97%,Tau2=1.5,19 studies,4552 patients). Patients had higher odds of significant alcohol use after surgery than before, OR 1.5(95% CI 1.07-2.11, I2=89%,Tau2=0.3,11 studies,3370 patients). Conclusion: Bariatric surgery is associated with significant increase in moderate to high-risk alcohol use/abuse with a new-onset incidence of 8%. Additionally, 19% of patients overall reported problem drinking prior to surgery. Thus, better selection of patients and further studies to identify modifiable factors are needed to decrease the substantial burden of high-risk alcohol use after bariatric surgery.Figure: New onset alcohol use after bariatric surgery seen in 8% of patients (I sq=0%; Tau sq=0; 5 studies; 2698 patients).Figure: Odds Ratio for significant alcohol abuse after bariatric surgery is 1.5 (95% CI 1.07-2.11;I sq=89%; Tau sq=0.3; 11 studies;, 3370 patients).